Candidacy and Evaluation of Pediatrics and Adults Flashcards
HAs vs. CIs
HAs acoustically amplify sound, relying on the responsiveness of the surviving hair cells.
CIs bypass absent or damaged hair cells and stimulate the nerve directly.
A Team Decision
Candidate in the center
- family/caregivers
- surgeon
- audiologist
- therapists (SLP, social worker)
- psychologist
- educational liaison
- teachers
Pediatrics Process
- Pre-operative Assessment
- surgery
- initial stimulation
- programming considerations
- follow-up routine
Goals of Pre-Operative Assessment
- determine if patient meets FDA candidacy criteria for AB
- assess non-audiologic factors influencing candidacy
- select ear to implant (or bilateral)
- counsel on potential benefits
- begin to set realistic expectations (UNDER-PROMISE and OVER-DELIVER)
- build positive rapport with patient and family
- provide resources for further info/education
FDA Criterion for pediatric AB CI
- 12 months - 17 yrs
- Profound bilateral SNHL (PTA > or = 90 dB HL)
- trial with appropriately fit HAs (can be waived)
- Little or no benefit from appropriately fit HAs
= Children or = 4: score of = 12% on difficult open-set word recognition test or = 30% on an open-set sentence test
Defining Benefit
What does benefit and success mean to the patient
- environmental sound awareness
- talking on phone
- ordering fast food meal
- ability to easily connect with family and friends
- being mainstreamed in school
- ability to hear parent say “I love you”
Pediatric Audiological Assessment
- ABR
- ECochG/Otoacoustic Emissions
- Tympanometry
- Behavioral audiometry
- Speech Perception Testing
Pediatric Speech Perception Tools
0-24 mos:
- parent questionnaires (i.e., IT-MAIS)
2-4 yrs (Live Voice Presentation)
- Questionnaires, Closed and Open sets
5+ yrs (Taped presentation)
- Questionnaire, closed and open sets
Pediatric CI Surgery
Requires general anesthesia
Procedure takes ~1-2 hrs
Typically done as outpatient procedure
patients typically recover quickly with advanced in implant technology and surgical techniques
Intra-Operative Testing
- typically completed by audiologists from CI center
- some surgeons complete this
- typically consist of:
= conditioning electrodes
= impedance measures
= NRI (recommend 4 electrodes: 3, 7, 11, 15)
Preparing for Initial Stim
- limit # of ppl in programming room
- prepare caregivers on what to expect
- utilize NRI
- charge batteries
CI Pediatric Challenges
- limited language
- limited experience with auditory input
- limited attention span
- behavioral and compliance issues
- distraction (extended family, teacher, therapist, etc.)
Pediatric Initial Stim
select strategy
- start with 1 strategy and give at least a few months-6 of use with a particular speech processing strategy
- provide a CONSISTENT signal in which to develop auditory skills and language
perform objective measures
establish M-Levels
- utilize objective measures to assist in setting; however, behavioral responses always ‘trump’ objective measures
set program parameters
verifying audibility
Pediatric Typical Initial Responses
- looking at parent, audiologist, or computer
- seeking reassurance
- touching implant site
- slight body reflexes
- change in play activity
- surprise, pleasure, concern, bewilderment
- sometimes no behavioral response exhibited
Pediatric
Signs that sound may be too loud
- more active/aggressive play
- tension behaviors- twisting toys, fingers
- body tensing
- getting hot/red in face
- eye blinking
- distress, tears
- CH removes HP +/- SP
Pediatrics
Setting Volume Control Range
- Goal- set VC to provide comfortable, consistent stimulation
- Young CH: restrict VC (-20 to 20)
- Very Young CH: restrict VC (-20 to 20 or ‘off’ 0 to 0)
Benefit may be influenced by:
- duration of HL
- age at time of fitting with amplification +/- implantation
- amount of HL or residual hearing
- etiology
- age at implantation
- mode of communication
- inconsistent function/use of CI
- presence of multiple handicapping conditions
- optimal fitting/programming of device(s)
- family support and follow-up
- (re)habilitation/therapy
Indications that re-programming/troubleshooting is needed
- decrease in speech perception ability
- decrease in speech production skills
- sudden resistance to wear
- concern reported for progress
- lack of expected progress over a period of time
- constant fiddling with device
Adult FDA Candidacy for AB CI
- bilateral severe-profound SNHL (PTA >/= 70 dB)
- Limited benefit from HAs: sentence score = 50% in ear to be implanted
- Healthy adult over 18 yrs
- Postlingual onset of deafness (after age 6 yrs)
Medical ContraIndications
- absence of cochlea or auditory nerve
- lesions of auditory nerve or central auditory pathway
- not healthy enough for anesthesia required for CI surgery
- active external or middle ear infection (needs to be eliminated before surgery)
Adult Speech Perception Testing
Presentation
- auditory only (listening)
- Audio-visual
- Visual only
Type of Set: open and closed
Materials: sentences, words, consonant identification in vowel context (VCV)
Minimum Test Battery for Adult
- 2 Lists HINT sentences in quiet
- 2 Lists HINT sentences in noise
- 1 List CNC Monosyllabic words
Adult Initial Experiences
- initial reactions wil vary among adult users
- increased sound input may be overwhelming at first
- although initially speech may sound distorted or squeaky, most users report that this perception soon disappears with consistent use
- during 1st 3 months of implant use, post-lingual CI users demonstrate significant increases in speech perception
Adult Revised MSTB (Minimal speech test battery)
Recommended protocol post-implant
- 1 20-sentence list of AzBio sentences in quiet
- 1 20-sentence list of AzBio sentences in noise
- 1 50-word list of CNC words
- 1 16-sentence list-pair (8 sentences per list) of BKB-SIN pre-operativley; 1 20-sentence list-pair (10 sentences per list) of BKB-SIN post-operatively
